Printed on 9-Mar-2021 at 15:05 Tax Invoice MOHAMMED UVESH .V. MALVAT Invoice No : 2017 Surveyor & Loss Assessor (Moter) Lic No SLA73478 Valid Upto August 2023 Dated : 9-Mar-2021 88 Sarani Society. 132' Ring Road B/h APMC MARKET Vasna ToInaka Insured Name : ANILKUMAR KAPADIYA Ahmedabad Gujarat - 380055, India Claim No : OC-21-2204-1803-00000499 GSTIN/UIN: 24AMHPM9424B1Z9 Contact : 9898070189 9925007717 Policy No : OG-21-2204-1803-00002352 E-Mail : uveshmalvat@gmail.com Make and Model : TATA LPT 1613 Motor Vehicle No : GJ11X8385 Shipped To Party Billed To Party BAJAJ ALLIANZ GIC LTD BAJAJ ALLIANZ GIC LTD 4TH FLOOR, TURQUOISE BUIL ,, NEAR 4TH FLOOR,TURQUOISE BUIL ,, NEAR PANCHVAtI , CROSSROAdS, C,G. ROAD PANCHVATI , CROSSROADS, C,G. ROAD AHMEDABAD 380006,Gujarat - 380006, India AHMEDABAD 380006,Gujarat - 380006, India State Name : Gujarat, Code : 24 State Name : Gujarat, Code : 24 GSTIN/UIN : 24AABCB5730G1Z3 GSTIN/UIN : 24AABCB5730G1Z3 PAN/IT No PAN/IT No Place of Supply: Gujarat SI Description of Goods HSN/SAC GST Amount No. Rate 1 01.01 Profesnal Fees 997162 18 % 500.00 2 01.02 Conyances Charges 997162 18 % 850.00 SURVEY AT BAGODARA TOLL PLAZA ONE WAY VISIT 65 KM 65KM X 2 = 130 KM 3 C GST 121.50 4 S GST 121.50 Total ? 1,593.00 Amount Chargeable (in words) E.&0.E Indian Rupees One Thousand Five Hundred Ninety Three Only HSN/SAC Taxable Central Tax State Tax Total Value Rate Amount Rate Amount Tax Amount 997162 1,350.00 9% 121.50 9% 121.50 243.00 Total 1,350.00 121.50 121.50 243.00 Tax Amount (in words) : Indian Rupees Two Hundred Forty Three Only Company's PAN : AMHPM9424B Declaration Company's Bank Details We declare that this invoice shows the actual price of the Bank Name : 06.01 ICICI BANK goods described and that all particulars are true and A/c No. : 034401511645 correct. Branch & IFS Code : Vasna Ahmedabad & ICIC0000344 Customer's Seal and Signature for MOHAMMED UVESH .V.MALVAT Authorised Signatory SUBJECT TO AHMEDABAD JURISDICTION SLA7 AHMEDABAD ---PAGE END---